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24A-021 (3) 45 BLACKBERRY LANE BP-2000-1069 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24A-021 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:windows replaced BUILDING PERMIT Permit# BP-2000-1069 Project# JS-2000-1910 Est.Cost: $5000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Valley Home Improvement, Inc 105543 Lot Size(sq. ft.): 1 001 8.80 Owner: HALL MARY F Inning. iTRB .4nnlicant: Valley H ;lr Imnrrvpment, Inc AT: 45 BLACKBERRY LANE Applicant Address: Phone: Insurance: P O Box 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON:5/30/00 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Rough Frame: Gas Fire Department Fireplace/Chimney: !tough: v►i: tnsuiat►on: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. eirror Certificate of Occu anc Si nature: Fee Type: Receipt No: Date Paid: Check No. Amount: Building 5/30/00 0:00:00 12006 $25 00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo lr" - ._..V 1 Department use o ii,, + of Northampton :,. 3= Permit: MAY 3 0 2000 :. ■ing Department eway Permit ---_-__. 2 Main Street :iC Availability_ DEPT OF BUILDING INSPECTIONS Room 100 va abil , NORTHAMPTON MA 01041 . :mpton, MA 01060 of Structural Plans phone 413-587-1240 Fax 413-587-1272 at/StePlan5__- ; ., Specify_ APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: 7 J This section to be completed byoffice Map J Lot o" tJni 45 Blackberry Lane �— Northampton, MA 01062 Zone Overlay District Elm St.0,404 _..._._ CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: n Mary Hall 45 Blackberry Lane --Name:' r' " Current Mailing Address: Northampton, MA 01060 Telephone Signature 584-0797 2.2 Authorized Agent; Nelson Shi f f l.e t t Valley Home Improvement, Inc_ P.O.. Box .60627, Florence, MA 01062 Name(Print) Current Mailing Address: �1 584_-7522 Si at re Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building ©O 0 G (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee t i 4. Mechanical(HVAC) 5. Fire Protection ^ l 6. Total =(1 + 2 + 3 +4 + 5) V v , Check Number /aOb lvo� 5� This Section For Official Use Only Building Permit Number: .p i,4„, Date issued:._ _ .__._ —� Signature: Building Commissioner/inspector of Buildings Date ._m ' ` ` ` '� ` ` ` � ��/ � . `` � � ./ . � � ` ` � _ � ' ' � . , ` ` ` � . . - ` . . . ' ` ^ . ` . . ` ��k � S �QNQ r"", ' ' w"�'' ^ .^~ ^. ' � ..- Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage % (Lot area minus bldg&paved (t) parking) #of Parking Spaces Fill: � f � � /� (volume&Location) ! e'"vAi 3 `/0(w, J A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO v DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ✓ DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO v DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property?YES No FCTI N 5 DESCRIPTION_OF PROPOSED WORK .heck all applicable) New House 0 Addition D Replace n Windows 1 Alteration(s) 0 Roofing 0 Or Doors Accessory Bldg. 0 DemolitionD New Signs [ ] Decks [ ] Siding[ ] Other[ Brief Description of Proposed Work: l //kt" cod✓J d , & 0S171& W.A\clay Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 . Renovating unfini hed basement Yes No Plans Attached Roll 0 • Sheet Li143// / Sr// ,<<f rc,rj / a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? Type of construction i. Is construction within 100 ft. of wet ands? Yes No. Is construction within 100 yr. floodplain Yes_ _No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No 1. Septic Tank City Sewer Private well City water Supply SECTI 7a , �AUTI,[ORIZAT OJ( 1*BtCOMP D WHEN W$E0**0 T CONTR 1 R PUSS F :BUILDI 1G PERMIT 1, Mary Hall , as Owner of the subject property hereby authorize Nelson Shifflett, Valley Home Improvement, Inc . to act on my behalf, in I matters relative to ork a th rized y t building permit application. Signature of Owner Date �- ✓ 1, Nelson Shifflett, Valley Home Improvement, Inc. , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Nelson Shifflett Print Name ayo`l Signature of Own r t Date I SECTION 8-CONSTRUCTION SERVICES .1 licensed Construction Supervisor: Not Applicable 0 Name of License Holder: Nelson Shifflett 060,30-0 Valley Home Improvment , Inc. License Number 320 Riverside Drive 9/00 Address Expiration Date Northampton, MA 01060 Signature Telephone l 584-7522 9,R _,t — -4: M w o - Not Applicable 0 Valley Home Improvement, Inc . 105543 Company Name Registration Number 320 Riverside Drive 7/17/00 Address Expiration Date Northampton, MA 01060 Telephone 584-7522 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c, 152, §25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. :Signed Affidavit Attached Yes No 0 11� The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor,CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official.that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature •• ': _ _ y r t' A )V J N�t y��rjj' e! K'ii - - 1 sv C•i: . s -Y C _ • itilK v� x - i t S rt } ,L7^• M1 " _ n: C1L\j�'1 L' -_ - OF - BUILDING - ;%•.1IN G? � O< t ram;_ .� ,�2 - - Main - Street- - Municipal- tut. ci a - - 1 - ray" - - Building - = - - North ;�,.�:.. �.. ,. a rn n Mass. 7os P - - - em;, VO R S COMPENSATION fISLE A�+ _z. - - r• r a a vI"i �, Ie .. a _f o�Y vsrcrt=n :ram-� � :_,: i censecJ 4. perms } t�z a r u�` fir; acre f�0 us).nessl r P esi P i� a P t: 320 i i versisJe Drive. `ort?iamp , do hereby certify rtia �und�v er-t�' pains t - an tha t:r• - etl- penalties - P a� t'S perjury, ram. = y :;. .:;.,.;�+ I axtir:.' , - % .1':,:.,:: M� �� employer providing the following worker's ~��::r_. ,:,.. �=_ =.. ;.::: .. -;;µ �;- rker's compensation coverage for ulv � t vs. � v �emp loyees ee wor king rl on i�' 1,l. _ Travelers r� a ebI In surance sur t Co.Cc� LB 88 8II9 9 8 _/ 1 If0 ce Y. � �Iasuran (Policy dumber (E.xpiration fin..,.,� .:. -. J ..+,:::-".::.•.a:;;+�"c -.-::'-.:-„i.,..1-..:,v'^::'i _ I .III :�».. sole proprietor, metal contractor _ homeo wner er(circle -:::�.* c.e one d an v- t f�::r ed - h ec contractors s listed below 4 w �s V �tt3 have the fo llowing V w7B worker's __r�e�'s co mpensation policies: es: - '.may-.a.�,.-;a.:: _ ':�i�`•';�=:::::: ,N�::,^�`:�::. Y of Contractor) tr1Ct r} (Insurance Company/Policy Number) (Expiration Da :;. � .:. — - ::. ,._. = ` r 1 '!Poficv Number) _ '(E�girail l� e)-:,. ,,..,... ^ - - - - .._.. (Name c_Contractor) CIrsurxn CcmP�3!PNnumber (Expiration •D (Name of Contractor) (Insurance Cozrlparxy,Tollcv Number) (Expiration Date) - tattachadditiomi slxct ifne esary Ucludc3f<rn.fipn pertaining to ail awdtcxors) .- ci v tier 0 r . and - have Pno P one - w o rkYn for - I am a - _��~=:;fir-;` ho me e - m owner e - z- e - rfn - _ all th e ew r _ - o _ _ - s l i 31112� _ ''l`.� _ ASV ..., _ - - leaae be aware:--,c' .p that while .,.:; cc>:,.._'z<;�:?�;a:,:'��:-..,.. not homcourtxrz who cmplay pczsosia t8 db t�+••',it�++�,;:r,construction or repair' on a of = - - usare than three units in inch the homeowner resides or on the grounds rsant $ esupl4yus urger the wvriccx z�cn fax GI 15 application therein are not g x pen or�asic3y a to be - enapi p,is of under employerCompensation { 2.ss l(5)),application.by a homeowner fora license or permit may evidence the _ amp y under the Worker's Cos tion Act -- i understand that a :......::.: .:� copy ot this ctasc tasy be Fawerdx!to 2n Deperurxr of I+sckriel Aaadmss Office of Imamate (x vctyfifar al V_ V . .lion and that failure to segue ccs <veragc under�iut:�_�rt cf - MC31,152 can( d to the vn of criminal penalties" <<;ic<`? <:'::?c ;= �.,.; cocniu%ag of a fine of up to t.500.00 aruUcsr ' rh ;; -r,:'.;,,.-. :c.:;:':-^; .-. '"' Mapritsonn=-it of up to Pm ytar and civil penalties in the Rani of:Scup Work and tt.4.';'z" `:;;,':::w';'.:. fine QPSIaCs.pU a day against me .. `- z _ ` SignedtllS ElaO 2006 For ceputmmtal use mty--Z;, . _ �•, k Permit Number - 1 - .r . •: ro-.W c 4-a�'~' � L . r =Yrim ;,: